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Background Anopheles stephensi  is an efficient vector of both  Plasmodium falciparum  and  Plasmodium vivax  in South Asia and the Middle East. The spread of  An. stephensi  to countries within the Horn of Africa threatens progress in malaria control in this region as well as the rest of sub-Saharan Africa. Methods The available malaria data and the timeline for the detection of An. stephensi was reviewed to analyse the role of  An. stephensi  in malaria transmission in Horn of Africa of the Eastern Mediterranean Region (EMR) in Djibouti, Somalia, Sudan and Yemen. Results Malaria incidence in Horn of Africa of EMR and Yemen, increased from 41.6 in 2015 to 61.5 cases per 1000 in 2020. The four countries from this region, Djibouti, Somalia, Sudan and Yemen had reported the detection of An. stephensi as of 2021. In Djibouti City, following its detection in 2012, the estimated incidence increased from 2.5 cases per 1000 in 2013 to 97.6 cases per 1000 in 2020. However, its contribution to malaria transmission in other major cities and in other countries, is unclear because of other factors, quality of the urban malaria data, human mobility, uncertainty about the actual arrival time of An. stephensi and poor entomological surveillance. Conclusions While An. stephensi may explain a resurgence of malaria in Djibouti, further investigations are needed to understand its interpretation trends in urban malaria across the greater region. More investment for multisectoral approach and integrated surveillance and control should target all vectors particularly malaria and dengue vectors to guide interventions in urban areas.

Background Malaria burden among under-five children living in endemic areas of Yemen is largely unknown due to the lack of community-based studies. Therefore, this study determined the prevalence and risk factors associated with falciparum malaria among under-five children in rural communities of Al-Mahweet governorate, Yemen. Methods This community-based, cross-sectional study recruited 400 under-five children from two rural districts of Al-Mahweet governorate in December 2019. Demographic characteristics (gender, age, education and occupation of the child’s parents, and household size) and risk factors associated with malaria were collected through interviews with children’s caregivers using a structured questionnaire. Finger-prick blood was screened for Plasmodium falciparum and non-falciparum species using rapid diagnostic tests (RDTs), and duplicate Giemsa-stained thick and thin blood films were examined for malaria parasites. The density of asexual P. falciparum stages was also estimated. Data were then analysed, and the agreement between the results of thick-film microscopy and RDTs for diagnosing falciparum malaria was assessed using the kappa index. Statistical significance was set at a P -value of < 0.05. Results Plasmodium falciparum was prevalent among 9.8% (95% CI 7.0–13.1) of under-five children in the rural communities of Al-Mahweet, with a median asexual parasite density of 763 ± 2606 parasites/μl of blood (range: 132–4280) and low-to-moderate parasitaemia levels. Approximately one-third of microscopy-confirmed cases were gametocyte carriers. Multivariable logistic regression analysis confirmed that age of three years or older (AOR = 5.6, 95% CI 1.6–19.8; P  = 0.007), not sleeping under a mosquito net the previous night of the survey (AOR = 8.0, 95% CI 2.4–27.4; P  = 0.001), sleeping outdoors at night (AOR = 4.4, 95% CI 2.0–10.0; P  < 0.001), and absence of indoor residual spraying (IRS) during the last year (AOR = 4.2, 95% CI 1.9–9.4; P  < 0.001) were the independent predictors of falciparum malaria among under-five children in the rural communities of Al-Mahweet. The observed percentage agreement between thick-film microscopy and RDTs was 98.5%, with a very good agreement ( k- index = 0.9) between the two methods for falciparum malaria diagnosis that was statistically significant. Conclusion Approximately one in ten under-five children in rural communities of Al-Mahweet is infected with P. falciparum based on microscopy and RDTs. Age of three years or older, not sleeping under mosquito nets, sleeping outdoors at night and absence of IRS can independently predict falciparum malaria among them. The very good agreement between thick-film microscopy and RDTs for diagnosing falciparum malaria in children supports the usefulness of using RDTs in such resource-limited rural communities.

We detected malaria vector Anopheles stephensi mosquitoes in the Al Hudaydah governorate in Yemen by using DNA sequencing. We report 2 cytochrome c oxidase subunit I haplotypes, 1 previously found in Ethiopia, Somalia, Djibouti, and Yemen. These findings provide insight into invasive An. stephensi mosquitoes in Yemen and their connection to East Africa.

Yemen is classified as high malaria endemic area with two-thirds of population at risk. Currently, the National Malaria Control Program (NMCP) uses two malaria surveillance systems: the Integrated Malaria Surveillance System (IMSS) and the Early Disease Electronic Warning System (eDEWS). This study aimed to assess and compare the usefulness and attributes of the two malaria surveillance systems. The systems were evaluated according to the US Centers for Disease Control and Prevention (CDC) updated guidelines. Data were collected from 10 stakeholders through interviews and from 10 districts’ coordinators and 20 health facilities’ focal points using semistructured questionnaire. The score of the system attributes were interpreted as very poor, poor, average, good, and excellent according to the mean percent score. Both systems were found to be useful. The IMSS overall performance score was poor where flexibility was average and simplicity, acceptability, representativeness, and stability were poor. For eDEWS, the overall performance score was good where data quality, acceptability, and flexibility were excellent; simplicity was good; representativeness was average; and stability was poor. In conclusion, although the IMSS was found to be useful for assessing the burden of malaria, response to outbreak, and future planning, the overall performance was poor. While the eDEWS overall level of performance was good, it was found to be useful only for outbreak detection. Therefore, both surveillance systems need to be integrated for the advantages of both systems to be maintained.

Anopheles stephensi is an invasive malaria vector in Africa. To determine the status of the mosquito in Yemen, An. stephensi vector surveillance and molecular confirmation was conducted in Al Hudaydah Governorate in 2021 and 2022. Mosquito larvae were collected in suspected man-made breeding habitats in Ah Dahi and Zabid city in 2021 and 2022, respectively. Mosquitoes morphologically identified as An. stephensi underwent molecular confirmation through PCR assays, sequencing, and phylogenetic analysis of the cytochrome oxidase subunit I (COI) gene and internal transcribed spacer 2 locus (ITS2). Analysis confirmed An. stephensi identification for the majority of samples (39/41), with two COI haplotypes detected: one newly reported haplotype and one haplotype common to Northeast Ethiopia and Somaliland. No clustering with An. stephensi from the Arabian Peninsula was observed. These findings provide preliminary insight into the diversity of An. stephensi in Yemen and the connection between An. stephensi in Yemen and East Africa.